The Shift in Healthcare is Imminent
The delivery of healthcare has been in the hands of hospitals and physicians for nearly a century. The government really started to exert their control when Medicare and Medicaid started in the 1960s. Large private insurance companies started to significantly exert their control in the 1970s.
With the coming of Obama care almost exactly a decade ago, the structure of health plans changed as their profit model counted on greater patient responsibility through high deductible and co-pays.
The failure of hospitals, physicians, pharmaceutical companies and insurance companies to be able to work together has caused consolidation.
Either as a cause or result of the consolidation, investors’ payback demands and greed have further exploded healthcare pricing. This past decade saw pharmaceutical companies and pharmacies dramatically raise their prices on common medications. One example was a commonly prescribed antibiotic that went from $4 to in excess of $600 for the same medication. Many hospitals and some physicians have similarly raised their prices but not to those extremes. Insurance companies have also posted record profits with no intention of slowing down. As a result, US employers large and small are losing their competitive advantage in an international economy and US patients are either foregoing healthcare or facing bankruptcy as even insured patients are realizing that their insurance is “subprime” and inadequate to cover their needs.
As a result, Congress and the Senate have proposed legislation that will essentially “rate set” some of the physician and pharmaceutical charges. Unfortunately, they have not realized or don’t have the political will to deal with the real problem, which is health plan design, and investor domination of insurance companies, pharmaceutical companies, and hospital and now practitioner organizations. However, as Congress and the Senate try to dance around and try to find temporary solutions to the insurance design crisis, some of our largest and innovative companies are somewhat silently creating a shift in healthcare delivery.
I think the signal occurred less than two years ago on January 30, 2018, when Amazon, Berkshire Hathaway, and J.P. Morgan announced the formation of the nonprofit Haven. More recently, Apple computer’s health-care market opportunity was estimated to be as high as a whopping $313 billion in revenue by 2027, according to estimates from a team of Morgan Stanley analysts. Apple has gone one step further and created a subsidiary ACwellness. Google is in the game as well with its company Verily Life Sciences. Not to be outdone even small retail companies like BestBuy are entering the market space and virtually every large direct to consumer retail company has entered the arena including CVS, Walgreens, Target, Walmart and Kroger.
The enabling pieces are also being put together. On October 30, 2019, both the US Congress and US senate announced bipartisan bicameral legislation to finally empower telehealth and telemedicine and on December 31, 2019, the American Medical Association announced called for support for the Interstate Medical Licensure Compact so that physicians can use telehealth to compete against vendors, retail clinics and payers moving into the space.
All of this is signaling the same thing. The industry resistance to change is over. Telehealth is the future and the future is imminent. The next several years will likely finally see a dramatic increase in the use of telehealth to improve healthcare delivery and decrease costs. This will likely decrease the delays in seeing a specialist, expand rural access to healthcare and decrease the need for medical transport to hospitals and often times physician’s offices. With every change, there will be winners and losers and there still will likely be resistance by those unable or unwilling to change. Likely this time, patient’s access to care will be faster, the care better, and the cost lower.
Paul Kivela, MD, MBA, FACEP is an emergency physician and CMO of ConveneMed, a telehealth company. He is a Past President of the American College of Emergency Physicians and has frequently spoken on the future of medicine.